Reactions 1300 - 8 May 2010

SRopivacaine

Pleural effusion and atelectasis duringinterscalene brachial plexus block: case report

A 41-year-old male developed pleural effusion andpulmonary atelectasis during continuous interscalenebrachial plexus block with ropivacaine for postoperativeanalgesia after shoulder arthroscopy.

Initially, the man received 30mL of ropivacaine 0.5%through a catheter into the brachial sheath. The subsequentrotator cuff repair was uneventful. Ropivacaine 0.2%[Naropin] infusion was initiated in the recovery room at arate of 6 mL/h with patient-controlled boluses of 3mL asrequired with a 20-minute lockout period. On thefirst postoperative day, he reported mild chest discomfort.Chest x-ray revealed elevation of the right hemidiaphragmand basal atelectasis of the right lower lobe with no pleuraleffusion. On the second postoperative day, he reportedmoderate chest discomfort and the chest x-ray revealedelevation of the right hemidiaphragm, basal atelectasis andpleural effusion without pneumothorax, findings suggestiveof acquired phrenic nerve palsy.

Ropivacaine infusion was discontinued and the man wasswitched to oral lornoxicam and IM diclofenac. By thefourth postoperative day his symptoms appeared to haveimproved but there was no improvement on chest x-ray.Chest x-ray on the sixth postoperative day showed that theright hemidiaphragm had returned to normal, but residualpleural effusion and atelectasis were still present. He wasdischarged on the eighth postoperative day. Completeexpansion of the collapsed lower right lobe was observedon chest x-ray on postoperative day 15.Yang CW, et al. Pleural effusion and atelectasis during continuous interscalenebrachial plexus block - A case report. Korean Journal of Anesthesiology 58: 95-98,No. 1, Jan 2010. Available from: URL: http://dx.doi.org/10.4097/kjae.2010.58.1.95- South Korea 803013502

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Reactions 8 May 2010 No. 13000114-9954/10/1300-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved